title: Transferring innovative freehand SPECT to the operating room: first experiences with sentinel lymph node biopsy in malignant melanoma.
abstract: OBJECTIVE
  The purpose of this study was to report on the first experiences with freehand single-photon emission-computed tomography (freehand SPECT) in sentinel lymph node biopsy (SLNB) in patients with malignant melanoma. Freehand SPECT is a novel imaging modality combining gamma probes, surgical navigation systems, and emission tomography algorithms, designed to overcome some of the limitations of conventional gamma probes.
  
  
  METHODS
  In this study 20 patients with malignant melanoma underwent conventional planar scintigraphy prior to surgery. In the operating room, the number and location of separable SLNs were detected first by a pre-incisional scan with freehand SPECT to render a 3D-image of the target site and afterwards by a scan with a conventional gamma probe. After SLNB another scan was performed to document the removal of all targeted SLNs.
  
  
  RESULTS
  Planar scintigraphy identified 40 SLNs in 26 nodal basins. Pre-incisional freehand SPECT mapped 38 of these nodes as well as one additional node in one patient (95.0% node based sensitivity). The results of freehand SPECT were identical to those of planar scintigraphy in 25 basins, while it missed one basin (96.2% basin based sensitivity). In comparison, the gamma probe failed to detect 7 nodes in 4 basins (82.5% node based sensitivity and 84.6% basin based sensitivity). After resection freehand SPECT detected 9 remaining radioactive spots, two of whichwere resected as they matched the position of SLNs detected on preoperative planar scintigraphy.
  
  
  CONCLUSIONS
  Freehand SPECT provides a real-time, intraoperative 3D-image of the radioactive labelled SLNs, facilitating their detection and resection.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: A L
authors.initials: AL
authors.lastname: Mihaljevic
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Rieger
authors.affiliation: Department of Dermatology, Technische Universität München, Biedersteiner Str. 29, 80802 Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Belloni
authors.affiliation: Department of Dermatology, Technische Universität München, Biedersteiner Str. 29, 80802 Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Hein
authors.affiliation: Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Okur
authors.affiliation: Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Scheidhauer
authors.affiliation: Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schuster
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany. Electronic address: martignoni@tum.de.
authors.forename: M E
authors.initials: ME
authors.lastname: Martignoni
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D009873:Operating Rooms; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Computer assisted surgery; Lymph node excision; Melanoma; SPECT; Sentinel lymph node biopsy; Surgical diagnostic techniques